פלסטיסיות מוחית בילדים עם המיפלגיה: מחקר בשיטות MRI מתקדמות
Exploring Brain Plasticity in Children with Hemiplegia:
An advanced MRI study
Dafna Ben Bashat1, Maya Weinstein1,2, Moran Artzi1,3, Ronny Geva2, Varda Gross-Tsur4, Shelly Shiran5, Vicki Myers1, Aviva Fattal-Valevski6, Andrew Gordon 7, Elka Miller8 Mitchell Schertz6 and Dido Green9,10
דפנה בן בעש"ט1, מאיה וינשטיין1,2, מורן ארצי1,3, רוני גבע2, ורדה גרוס- צור4, שלי שירן5, ויקי מאיירס1, אביבה פטאל-ולבסקי6, אנדרו גורדון7, אלקה מילר8, מיטשל שערץ6, דידו גרין9,10
1The Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Neuropediatric Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; 5Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 6Paediatric Neurology Unit, Tel Aviv Medical Center, Tel Aviv; 7Department of Biobehavioral Sciences, Columbia University, New York, USA; 8Diagnostic Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada; 9Department Occupational therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 10Health and Life Sciences, Oxford Brookes University, Oxford, UK
Acknowledgement: We would like to thank the Israeli Foundation for Handicapped Children (ILAN) and Beit Issie Shapiro for their ongoing support of this project.
Brain injury early in life may result in structural and functional abnormalities, accompanied by brain re-organization in an attempt to compensate for the injury. This study aimed to investigate differences in brain structure and function in children with hemiplegia (HC) compared to typical developing children (TDC) and their correlation to neurobehavioral assessments.
Eighteen HC and sixteen TDC underwent MRI examination including volumetric scans, motor functional-MRI and diffusion tensor imaging. Motor evaluation including the Assisting-Hand-Assessment and the Jebsen-Taylor Test of Hand-Function was conducted in children with hemiplegia.
Compared to TDC, HC displayed significantly reduced total white matter volume (33% versus 37%) and reduced integrity in the affected corticospinal-tract, midbody and splenium of the corpus callosum and posterior-limb-of-the-internal-capsule (p<0.01). These results were detected by average of 12% increased mean, axial and radial diffusivity and reduced fractional-anisotropy. Preserved gray-matter volume was detected in HC, compensated by increased cortical-thickness and reduced surface-area in the contra-lateral hemisphere. These findings were mainly detected in language, temporal, superior-frontal and sensory-motor areas. Abnormal activation patterns were detected in the primary motor-areas in HC, with bilateral activation (HC: LI=0.5±0.6 and TDC: LI=0.92±0.12) and/or reduced percent activation (HC=62±30%, TDC=80±15%) in the affected hemisphere. Associations were detected between several imaging parameters and behavioural measures.
Results from this study show a general WM impairment accompanied by cortical re-organization in children with hemiplegia. Imaging findings will be discussed in the context of brain plasticity following perinatal injury. Advanced imaging parameters may serve as biomarkers for prognosis and early intervention in hemiplegia.